Healthcare providers perceptions of barriers and facilitators to implementation of an acute traumatic brain injury clinical practice guideline: a CFIR-informed qualitative study at a regional referral hospital in Northern Tanzania
- 1Kilimanjaro Christian Medical Centre
Abstract
BackgroundTraumatic brain injury (TBI) is a major cause of morbidity and mortality in low-and middle-income countries (LMICs), where the burden of injury is disproportionately high, and healthcare resources are often limited. Clinical Practice Guidelines (CPGs) improve the consistency and quality of TBI care by shifting medical decision-making from individual judgement to evidence-based recommendations. The strong link between improved TBI outcomes and CPG adoption has largely been established in high-income country (HIC) hospital settings; evidence on implementing TBI CPGs in LMIC hospital settings is limited.
ObjectiveThis study explored healthcare providers experiences to identify barriers and facilitators to implementing a TBI CPG in the Emergency Department (EMD) at Kilimanjaro Christian Medical Center in Northern Tanzania, guided by the Consolidated Framework for Implementation Research 2.0 (CFIR).
MethodsWe conducted semi-structured in-depth interviews (IDIs) with doctors and nurses who regularly managed TBI patients at the EMD. We purposively sampled participants between June and August 2023. The research team analysed data using thematic content analysis guided by CFIR domains, developing codes and memos iteratively.
Results7 nurses and 8 doctors with an average of 5 years of experience caring for patients in the EMD completed in-person, in-depth interviews. Most providers reported frequent exposure to TBI cases and regular use of the CPG in routine clinical practice. However, not all participants reported consistent CPG use, highlighting variation in implementation among providers. Key facilitators included strong interprofessional teamwork, readily accessible guideline materials in clinical areas, availability of diagnostic imaging, and perceived improvements in patient outcomes. Barriers to consistent adherence included ICU bed shortages, limited operating theatre capacity, equipment and medication stock-outs, high patient volumes, staffing pressures, and a lack of structured refresher training or formal audit and feedback mechanisms. Variability in procedural confidence, particularly among less experienced providers, also affected implementation consistency.
ConclusionOur findings show that a TBI CPG is well accepted and largely integrated into routine care among experienced providers. However, sustainability depends on strengthening training, mentorship, audit, and feedback systems for CPG use and on addressing system-level resource constraints. Institutional investment in capacity building is essential to ensure consistent and sustained CPG uptake in our setting.
Related
- Patients' and Providers' Perceptions of the Implementation of a Stepped Care Cognitive-Behavioral Therapy for Insomnia in Routine Cancer Care: A Qualitative Post-Implementation Study.
- Maternity care providers' use of health literacy tools and perceptions of barriers and facilitators
- Pre-implementation barriers and facilitators to implementing a physical activity guideline for community-dwelling older adults with mild cognitive impairment: a qualitative stakeholder study
- Caregivers’ and healthcare providers’ perceptions of blood availability, safety, and acceptability for patients with cancer in southwestern Uganda
- Oncology nurses' perceptions of barriers and facilitators to CAUTI prevention: a qualitative study guided by the nursing role effectiveness model.
BibTeX
@misc{saria2026healthcare,
title = {{Healthcare providers perceptions of barriers and facilitators to implementation of an acute traumatic brain injury clinical practice guideline: a CFIR-informed qualitative study at a regional referral hospital in Northern Tanzania}},
author = {V. F. Saria and G. G. Zaccheus and J. R. N. Vissoci and F. Sakita and W. C. Mwita and L. Minja and T. A. Peter and J. V. P. d. Souza and K. Madundo and B. T. Mmbaga and C. A. Staton and A. Tupetz},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.04.26364725},
url = {https://www.medrxiv.org/content/10.64898/2026.10.04.26364725v1},
note = {CC0},
}
RIS
TY - UNPB
TI - Healthcare providers perceptions of barriers and facilitators to implementation of an acute traumatic brain injury clinical practice guideline: a CFIR-informed qualitative study at a regional referral hospital in Northern Tanzania
AU - V. F. Saria
AU - G. G. Zaccheus
AU - J. R. N. Vissoci
AU - F. Sakita
AU - W. C. Mwita
AU - L. Minja
AU - T. A. Peter
AU - J. V. P. d. Souza
AU - K. Madundo
AU - B. T. Mmbaga
AU - C. A. Staton
AU - A. Tupetz
PY - 2026
DA - 2026/10/04
PB - medRxiv
DO - 10.64898/2026.10.04.26364725
UR - https://www.medrxiv.org/content/10.64898/2026.10.04.26364725v1
AB - BackgroundTraumatic brain injury (TBI) is a major cause of morbidity and mortality in low-and middle-income countries (LMICs), where the burden of injury is disproportionately high, and healthcare resources are often limited. Clinical Practice Guidelines (CPGs) improve the consistency and quality of TBI care by shifting medical decision-making from individual judgement to evidence-based recommendations. The strong link between improved TBI outcomes and CPG adoption has largely been established in high-income country (HIC) hospital settings; evidence on implementing TBI CPGs in LMIC hospital settings is limited. ObjectiveThis study explored healthcare providers experiences to identify barriers and facilitators to implementing a TBI CPG in the Emergency Department (EMD) at Kilimanjaro Christian Medical Center in Northern Tanzania, guided by the Consolidated Framework for Implementation Research 2.0 (CFIR). MethodsWe conducted semi-structured in-depth interviews (IDIs) with doctors and nurses who regularly managed TBI patients at the EMD. We purposively sampled participants between June and August 2023. The research team analysed data using thematic content analysis guided by CFIR domains, developing codes and memos iteratively. Results7 nurses and 8 doctors with an average of 5 years of experience caring for patients in the EMD completed in-person, in-depth interviews. Most providers reported frequent exposure to TBI cases and regular use of the CPG in routine clinical practice. However, not all participants reported consistent CPG use, highlighting variation in implementation among providers. Key facilitators included strong interprofessional teamwork, readily accessible guideline materials in clinical areas, availability of diagnostic imaging, and perceived improvements in patient outcomes. Barriers to consistent adherence included ICU bed shortages, limited operating theatre capacity, equipment and medication stock-outs, high patient volumes, staffing pressures, and a lack of structured refresher training or formal audit and feedback mechanisms. Variability in procedural confidence, particularly among less experienced providers, also affected implementation consistency. ConclusionOur findings show that a TBI CPG is well accepted and largely integrated into routine care among experienced providers. However, sustainability depends on strengthening training, mentorship, audit, and feedback systems for CPG use and on addressing system-level resource constraints. Institutional investment in capacity building is essential to ensure consistent and sustained CPG uptake in our setting.
ER -